Provider Demographics
NPI:1710697651
Name:STALLWORTH, ARVITA L (MA ,MCR,HHA)
Entity Type:Individual
Prefix:
First Name:ARVITA
Middle Name:L
Last Name:STALLWORTH
Suffix:
Gender:F
Credentials:MA ,MCR,HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 TAOS DR
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-4504
Mailing Address - Country:US
Mailing Address - Phone:937-231-4106
Mailing Address - Fax:
Practice Address - Street 1:2831 TAOS DR
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-4504
Practice Address - Country:US
Practice Address - Phone:937-231-4106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide